Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 19-2), which displays information about disparities among select populations for which data were available for assessment.

NHANES is used to monitor the majority of population-based objectives in this focus area, including three weight-related objectives (19-1, 19-2, and 19-3), seven dietary intake objectives (19-5 through 19-11), and one objective on iron deficiency (19-12). Although the Continuing Survey of Food Intakes by Individuals (CSFII) was the baseline data source for five dietary intake objectives (19-5 through 19-9), NHANES is the data source for updates for these objectives after the dietary component of these two surveys merged. In general, NHANES can be used to monitor disparities by gender, income, and race and ethnicity for the white non-Hispanic, black non-Hispanic, and Mexican American populations. The CSFII provided baseline estimates by gender, income, and race and ethnicity for the white non-Hispanic, black non-Hispanic, and Hispanic populations.

As shown in Figure 19-2, the weight status objectives and subobjectives (19-1, 19-2, and 19-3) demonstrated disparities within race and ethnicity, gender, income, and disability. White non-Hispanic persons had the best rates in 1999–2002 for all the weight-related objectives and subobjectives (19-1, 19-2, and 19-3), compared with other racial and ethnic groups with data available.

Although the trend toward increasing obesity in adults (19-2) occurred among all three racial and ethnic groups for which Healthy People 2010 data were available, the increase was more pronounced for the black non-Hispanic population (30 percent to 39 percent) and the white non-Hispanic population (22 percent to 30 percent) than for the Mexican American population (29 percent to 31 percent). Disparity in adult obesity between the Mexican American and the white non-Hispanic (best) populations declined. Despite the decrease in disparity, the obesity prevalence for both groups increased and moved away from their targets.

Between 1988–94 and 1999–2002, the disparity in overweight or obesity for children aged 6 to 11 years (19-3a) between Mexican American and black non-Hispanic populations declined. Among persons aged 6 to 19 years (19-3c), the prevalence was at least 50 percent higher in the Mexican American and black non-Hispanic populations than in the white non-Hispanic population.

Between 1988–94 and 1999–2002, the prevalence of obesity (19-2) among males aged 20 years and older increased from 20 percent to 27 percent; for females, it increased from 25 percent to 33 percent. Among persons aged 20 years and older (19-2), males had a lower prevalence of obesity than females, but among persons aged 6 to 19 years (19-3c), females had a lower prevalence of overweight or obesity than males.

Among persons aged 20 years and older, people without disabilities had better rates for healthy weight (19-1) and obesity (19-2) than people with disabilities. The higher income population had better rates for healthy weight in persons aged 20 years and older (19-1), obesity in persons aged 20 years and older (19-2), and overweight or obesity in persons aged 6 to 19 years (19-3c). The disparity decreased between lower and higher income adolescents who are overweight or obese (19-3b), but this decrease did not reflect progress because both groups moved away from the target. Additional data analyses are needed to fully estimate differences in associated health risks in relationship to body mass index disparities.

Data from the Centers for Disease Control and Prevention's (CDC's) Pediatric Nutrition Surveillance System were available to monitor disparities in growth retardation among low-income children under 5 years of age (19-4), by race, ethnicity, and gender for the white non-Hispanic, black non-Hispanic, Hispanic, American Indian or Alaska Native, and Asian or Pacific Islander populations. In 2003, the American Indian or Alaska Native population had the best rate for growth retardation (5 percent). From 1997 to 2003, the disparity between the Asian or Pacific Islander and the American Indian or Alaska Native populations decreased. Female children had a better rate than male children.

Disparities in baseline dietary intake estimates for seven objectives (19-5 through 19-11) were also present. The Hispanic population had the best rates in 1994–96 for three objectives: fruit intake (19-5), saturated fat intake (19-8), and total fat intake (19-9). The Mexican American and black non-Hispanic populations had the best rates in 1988–94 for sodium intake (19-10). The white non-Hispanic population had the best rate in 1994–96 for grain intake (19-7) and in 1988–94 for calcium intake (19-11). Higher income persons had better rates for all the dietary intake objectives except sodium.

Disparities were monitored in objectives and subobjectives dealing with iron deficiency and anemia (19-12 and 19-13). Data from NHANES indicated that lower income nonpregnant women had a higher prevalence of iron deficiency (19-12c) than higher income women. Data from CDC's Pregnancy Nutrition Surveillance System indicated that for anemia in low-income pregnant women in their third trimester (19-13), the Asian or Pacific Islander population had the best rate (24 percent). The prevalence of anemia among the black non-Hispanic population was at least 50 percent higher than that of the Asian or Pacific Islander population.

Data from the Food Security Supplement to the Current Population Survey were also available to assess disparities by race or ethnicity for the white non-Hispanic and black non-Hispanic, Hispanic, Asian or Pacific Islander, and American Indian or Alaska Native populations and by income for food security (19-18). In 2003, white non-Hispanic households had the best rate for food security (92 percent). Food insecurity among black non-Hispanic, Hispanic, and American Indian or Alaska Native households was nearly three times that of white non-Hispanic households. The proportion of lower income households that experienced food insecurity was more than four times that of higher income households. Although the disparity between lower and higher income households declined between 1995 and 2003, both income groups moved away from the target.

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